Provider Demographics
NPI:1053730903
Name:ROLAND PRIMARY CARE CLINIC LLC
Entity type:Organization
Organization Name:ROLAND PRIMARY CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUOCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-503-6276
Mailing Address - Street 1:309 E RAY FINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-5160
Mailing Address - Country:US
Mailing Address - Phone:918-503-6276
Mailing Address - Fax:941-850-3627
Practice Address - Street 1:309 E RAY FINE BLVD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5160
Practice Address - Country:US
Practice Address - Phone:918-503-6276
Practice Address - Fax:941-850-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty